Segmentation of family medicine

Nicholas Pimlott

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RE: the need for a GP
Robert W Shepherd

Published on: 05 November 2018

Published on: (5 November 2018)
Page navigation anchor for RE: the need for a GP
RE: the need for a GP
Robert W Shepherd, family physician, UBC and U Vic
Dr. Pimlott quoted Dr. Rosen, who stated that "...repeated face to face consultation with a doctor is seen as the wrong approach... with technology-enabled consultations with a variety of health professions offering new options for assessment, review and treatment." Computerized algorithms are used by companies, universities and governments to decide who should have credit, get accepted to university, receive advertising, get a job interview, get insurance, and be offered a lenient decision by a court (1).

People labeled untrustworthy by an algorithm have difficulty navigating the system. The family doctor is perhaps the most highly educated publicly funded person who can help the patient access knowledge and services, including health benefits.

Tests to detect cancer in asymptomatic people are promoted by the slogan "Screening saves Lives." It does, but It also leads to a lot of testing and treatment, not all of which is beneficial (2, 3). My patients and I get reminders about the patient being overdue for a Pap test and for the fecal immunochemical test. Both reminders come from the BC Cancer Agency. One has a doctor's name at the bottom of the notice, and the other has no name on it. I asked the person whose department created the second notice why the notice had no name. The reply was, "(the notification) is generated out of the Screening Program data base and is not sent by a person."

The patient needs h...
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Dr. Pimlott quoted Dr. Rosen, who stated that "...repeated face to face consultation with a doctor is seen as the wrong approach... with technology-enabled consultations with a variety of health professions offering new options for assessment, review and treatment." Computerized algorithms are used by companies, universities and governments to decide who should have credit, get accepted to university, receive advertising, get a job interview, get insurance, and be offered a lenient decision by a court (1).

People labeled untrustworthy by an algorithm have difficulty navigating the system. The family doctor is perhaps the most highly educated publicly funded person who can help the patient access knowledge and services, including health benefits.

Tests to detect cancer in asymptomatic people are promoted by the slogan "Screening saves Lives." It does, but It also leads to a lot of testing and treatment, not all of which is beneficial (2, 3). My patients and I get reminders about the patient being overdue for a Pap test and for the fecal immunochemical test. Both reminders come from the BC Cancer Agency. One has a doctor's name at the bottom of the notice, and the other has no name on it. I asked the person whose department created the second notice why the notice had no name. The reply was, "(the notification) is generated out of the Screening Program data base and is not sent by a person."

The patient needs help to decide what is best for him or her. The family doctor can review with a patient the risks and benefits of testing or treatment, including the goals of the proposed intervention, and the number needed to treat and the number needed to harm.

Canadian doctors move at the privileged end of the social spectrum. Even we can be excluded from decisions which affect us -- the Canadian Medical Association did not consult its membership before selling MD Management to a bank. The family practitioner marshals scientific evidence and deep knowledge of the patient to help the patient make the best decision for himself or herself. In the age of computerized decision-making by big entities, our role is more important than ever.

(1) Cathy O'Neil, "Weapons of Math Destruction," Crown Publishing, New York, 2016.

(2) Nikola Biller-Andorno and Peter Jueni, "Abolishing Mammography Screening Programs? A View from the Swiss Medical Board," New England Journal of Medicine;370(21):1965-7.

(3) Gerald L. Andriole et al, "Mortality Results from a Randomized Prostate-Cancer Screening Trial." New England Journal of Medicine;360(13):1310-9.

Robert Shepherd, Victoria BC
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Competing Interests: None declared.